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Pizzi M, Friziero A, Vianello F, Binotto G, Da Dalt G, Zoletto S, Carraro E, Fassan M, Sbaraglia M, Sperti C, Baldan N, D'Amore F, Bertozzi I, Righi S, Pierobon ES, Moletta L, Capovilla G, Grego A, Sabattini E, Fabris F, Merigliano S, Dei Tos AP. Histology of the spleen in immune thrombocytopenia: clinical-pathological characterization and prognostic implications. Eur J Haematol 2020; 106:281-289. [PMID: 33190299 DOI: 10.1111/ejh.13547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Immune thrombocytopenia (ITP) is an acquired disorder, characterized by immune-mediated platelet destruction. The spleen plays a key pathogenic role in ITP and splenectomy is a valuable second-line therapy for this disease. Little is known on ITP spleen histology and response to splenectomy is unpredictable. This study aims to characterize ITP spleen histology and assess possible predictors of splenectomy outcome. METHODS A series of 23 ITP spleens were retrospectively assessed for the following histological parameters: density of lymphoid follicles (LFs), marginal zones (MZs), T helper and cytotoxic T cells; presence of reactive germinal centers (GCs); width of perivascular T cell sheaths; and red pulp features. Clinical and histological data were matched with postsplenectomy platelet counts to assess their prognostic relevance. RESULTS Three histological patterns were documented: a hyperplastic white pulp pattern, a non-activated white pulp pattern (lacking GCs), and a white pulp-depleted pattern. Poor surgical responses were associated with presplenectomy high-dose steroid administration, autoimmune comorbidities and low T follicular helper cell density. The combination of such parameters stratified patients into different splenectomy response groups. The removal of accessory spleens was also associated with better outcome. CONCLUSION ITP spleens are histologically heterogeneous and clinical-pathological parameters may help predict the splenectomy outcome.
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Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Alberto Friziero
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fabrizio Vianello
- Hematology and Clinical Immunology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Gianni Binotto
- Hematology and Clinical Immunology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Gianfranco Da Dalt
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Simone Zoletto
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Elisa Carraro
- Oncohematology Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
| | - Matteo Fassan
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Cosimo Sperti
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Nicola Baldan
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fabio D'Amore
- Hematology and Clinical Immunology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Irene Bertozzi
- 1st Medical Clinic, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Simona Righi
- Haematopathology Unit, Sant'Orsola Hospital, Bologna, Italy
| | - Elisa Sefora Pierobon
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Lucia Moletta
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giovanni Capovilla
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Andrea Grego
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | | | - Fabrizio Fabris
- 1st Medical Clinic, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Stefano Merigliano
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
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